Robotic TME with nerve sparing and Fluorescence

Giuseppe Spinoglio (Candiolo – Italy) L.M. Lenti, F. Priora, F. Ravazzoni, R. Quarati

We present a case of Totally Robotic Anterior resection with TME nerve sparing and Fluorescence imaging . ICG fluorescence is used for lymphatic mapping, nerve sparing and bowel perfusion of colo-rectal stumps. ICG is injected preoperatively into peritumoral submucosa . The operation starts with the section of gastro-colic ligament. After splenic flexure take down a fluorescence-guided lymphadenectomy of the inferior mesenteric artery (IMA) is performed. The IMA and the IMV are clipped and cut and dissection between Toldt and Gerota fascia is completed. Then the TME is performed. The perfusion of the distal rectum is evaluated in fluorescence after an ICG intravenous injection done before the section. The surgical specimen is extracted through a Pfannenstiel incision . A side to end anastomosis is completed and a control of perfusion with fluorescence is eventually performed. Institution: SS. Antonio e Biagio City Hospital City: Alessandria Country: Italy